Intracytoplasmic Sperm Injection (ICSI)


A quick look at ICSI


ICSI or intracytoplasmic sperm injection is a procedure that injects sperm into the cytoplasm area of an egg where fertilization takes place. This procedure takes place during the fertilization stage of the in vitro fertilization (IVF) process.

The benefit of ICSI is to greatly improve the chance of a man’s sperm fertilizing a woman’s egg during IVF to result in pregnancy. ICSI is most often used in cases of male infertility, where problems with quantity, shape or movement of a man’s sperm lowers chances of fertilizing the egg.

Risks of ICSI itself are minimal and include low chances of damaging the egg during sperm injection.

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What is intracytoplasmic sperm injection?

Intracytoplasmic sperm injection, more commonly called ICSI (ick-see), is a procedure performed in conjunction with IVF that directly inserts a sperm into the woman’s egg for fertilization. The steps of IVF with ICSI are nearly the same as traditional IVF: ovarian stimulation, egg and sperm retrieval, fertilization (using ICSI instead of allowing sperm to fertilize the egg on its own in a lab dish) and embryo transfer. As a form of assisted reproduction, intracytoplasmic sperm injection has been in use since the early 1990s.

Related Information: Learn More about IVF

The injection procedure takes place during the fertilization stage of IVF. In traditional IVF, an egg is placed in a lab dish with tens of thousands of sperm in the hopes that one will fertilize the egg. During IVF with ICSI, a man’s semen is prepared by separating the good sperm from the bad sperm and other debris in the semen. Good sperm will have optimal shape and movement for fertilization.

A Positive Steps Fertility embryologist will then use a high-powered microscope to identify a single healthy sperm and pick it up with a tiny, hollow needle. The sperm is then injected through the tough, outer shell (zona pellucida) of the egg and into the cytoplasm. This is often done to several eggs at a time. If fertilization is successful, an embryo will develop that can be transferred into the woman’s uterus or frozen for use in a future IVF treatment. This process has a 70-85 percent fertilization success rate.

Who should consider ICSI?

For couples experiencing male infertility, the sperm count may not be of the needed quantity or quality to penetrate and fertilize the egg. In these cases, traditional IVF may not work, and so IVF with intracytoplasmic sperm injection will increase the chances of success.

ICSI is very effective for couples that have the following male infertility issues:

  • Low sperm quantity, measured as less than 20 million sperm per milliliter, which is inadequate for successful IVF or intrauterine insemination (IUI)
  • Various problems with sperm quality that may affect the sperms’ ability to penetrate and fertilize the egg
  • A blockage in the male reproductive tract that prevents the sperm from being released in ejaculation, necessitating retrieval of the sperm and use of the sperm injection method. The blockage may be a result of vasectomy or an injury to the area.
  • Poor motility or movement, which makes it hard for the sperm to move through a woman’s reproductive tract to reach the egg or move toward and fertilize the egg during IVF.

IVF with ICSI has good success rates for couples who have previously tried IVF that resulted in low fertilization rates. Intracytoplasmic sperm injection also works well for women who do not have a large number of eggs retrieved from the ovaries, because it generally ensures a higher percentage of fertilized eggs than with traditional fertilization during IVF.


While the risks of complications from ICSI are very low, some research has linked the procedure to a slightly increased risk of:

  • Passing on low sperm count to a male child
  • Conceiving a baby with sex chromosome abnormalities or certain genetic defects.

These risks, however, may be caused by underlying infertility issues rather than the sperm injection procedure itself. Preimplantation genetic testing is sometimes encouraged in cases of male infertility, as men with very low sperm counts have a higher risk of passing on genetic defects.

Another risk of ICSI is a risk of IVF itself – a greater chance of a multiple pregnancy when transferring more than one embryo. Multiple pregnancy (twins or more) carries a higher risk of complications to both the mother and the babies. According to American Society for Reproductive Medicine, once fertilization via ICSI occurs, the chance of a multiple pregnancy is the same as for IVF without ICSI. This risk can be lessened by limiting the number of embryos transferred to a woman’s uterus to one (elective single embryo transfer, or eSET), or no more than two.

Next steps: See if you need IVF with ICSI

Increase your chance for pregnancy success with IVF and intracytoplasmic sperm injection. Call us to set up an initial consultation, in which you can discuss your questions about your fertility options with us. Positive Steps Fertility welcomes new patients and we currently have short wait times for an appointment.